Provider Demographics
NPI:1689041642
Name:ROWE-WALLACE, TAMMY (CLD(CBI))
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ROWE-WALLACE
Suffix:
Gender:F
Credentials:CLD(CBI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 DIRIGO DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2368
Mailing Address - Country:US
Mailing Address - Phone:207-922-2200
Mailing Address - Fax:
Practice Address - Street 1:46 DIRIGO DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2368
Practice Address - Country:US
Practice Address - Phone:207-922-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula